Burning Mouth Syndrome

Burning mouth syndrome is an uncommon oral disorder, with a reported prevalence ranging from 0.7 up to 15% of the population. Also known as glossodynia, burning mouth syndrome tends to affect women up to 7 times more often than men, typically in their post-menopausal years. This condition is benign and characterized by the absence of any obvious abnormalities in the mouth or on blood tests.

Symptoms of Burning Mouth Syndrome

As the name suggests, burning mouth syndrome involves a burning sensation around the mouth, though some patients may describe the sensation as pain, scalding, or tingling. This can be experienced anywhere in the mouth, but is most commonly found on the tongue, roof of the mouth, or inner surface of the lips. Other reported symptoms include:

• Dry mouth
• Changes to taste, including a lessened sensation of taste when eating and drinking, or an unusual sour, bitter, or metallic taste in the mouth
• Intermittent numbness of the mouth
• A crawling sensation in the mouth

The exact symptoms and location of symptoms in the mouth can vary from individual to individual. Different patients also report differing patterns to their symptoms. Some may find their symptoms worsen throughout the day; others report continuous and unchanging symptoms from morning to night; others may find their symptoms come and go from day to day.

Causes of Burning Mouth Syndrome

The cause of burning mouth syndrome is not fully understood, but is thought to be due to a form of neuropathy, indicating a disorder of the nerves involved with taste and pain sensations in the mouth. Risk factors for this condition include:

• Menopause
• Stress
• Psychiatric disorders, such as anxiety and depression
• Chronic fatigue
• Fibromyalgia

However, note that a risk factor does not mean these conditions cause burning mouth syndrome, but are simply associated with a higher likelihood of the two occurring together.

Burning mouth syndrome is sometimes confused with other identifiable oral disorders that present with a similar burning or painful sensation in the mouth. Oral thrush, oral lichen planus, Sjogren’s syndrome, vitamin deficiencies, poorly fitted dentures, teeth grinding, allergies and some medications can all be associated with a painful mouth but are not true cases of burning mouth syndrome.

Diagnosis and Treatment

By definition, burning mouth syndrome is not associated with any observable abnormalities of the mouth, making this condition a diagnosis of exclusion. This means your healthcare provider must first investigate other causes of your symptoms and if there is no other identifiable explanation, a diagnosis of burning mouth syndrome may be given.

Dentists, specialists in oral medicine, or an ENT (ear, nose, throat) specialist are all appropriate healthcare practitioners who may investigate burning mouth syndrome. A dentist or oral medicine specialist will assess you for any conditions such as tooth grinding, jaw clenching, or mouth infections. Medical specialists such as an ENT doctor can order blood testing, allergy testing, assessment of your salivary gland function, tissue biopsies, or medical imaging to rule out other causes of your symptoms.

There is currently no definitive cure for burning mouth syndrome. Primary glossodynia (that is, burning mouth symptoms not caused by another underlying condition) can be managed in a number of ways. The most effective management techniques for one patient may be different for another, but may include:

• Clonazepam medication to mute activity from the nervous system
• Certain antidepressants, such as sertraline or gabapentin
• Sipping cold drinks or sucking on ice chips
• Avoiding irritants, including spicy or acidic foods, tobacco, and alcohol
• Cognitive behavioral therapy, psychotherapy, or other forms of stress management

Some patients have found that alpha-lipoic acid to be helpful, as well as topical anesthetic or anti-inflammatory medications, though these are not useful for everyone.

If an underlying cause of the burning mouth symptoms can be identified, such as an infection in the mouth or teeth grinding, addressing these problems directly should relieve the symptoms.

Fortunately, even if no treatment is initiated, around half of patients with burning mouth syndrome find their symptoms self-resolve after a few years.